dotFIT Certification Integrated Training 1 The Scientific Rationale Today’s Society To understand the rationale behind integrated training, it’s imperative for the health and fitness professional to first understand the current state of today’s society. In addition to the current obesity epidemic, the number of older individuals is also growing rapidly. The U.S. Census Bureau reports that the proportion of the population over 65 is projected to increase from the 12% reported in 2000 to almost 20% by 2030. This lends to the number of individuals developing chronic diseases and disability. In the United States, approximately 80% of all persons 65 or older have at least one chronic health condition, and 50% have at least two. One in five adults report having doctor-diagnosed arthritis which is a leading cause of disability in the U.S. Meanwhile, daily activity levels continue to decline. People are less active and are no longer spending as much of their free time engaged in physical activity. Physical education and after-school sport programs are being cut from school budgets, further decreasing the amount of physical activity in children’s lives. This new environment is producing more inactive and non-functional people, leading to structural deficiencies and injury. Evidence of Increased Injury and Musculoskeletal Pain Research suggests that musculoskeletal pain is more common now than it was 40 years ago. This lends support to the concept that decreased activity may lead to muscular dysfunction and, ultimately, injury. Some of the major health topics of interest include low back pain, knee injuries, chronic diseases, such as heart disease and diabetes, and musculoskeletal injuries. Low back pain is one the major forms of musculoskeletal degeneration seen in the adult population, affecting nearly 80 percent of all adults. It is common among workers in enclosed workspaces, such as offices, as well as those who sit for periods of time greater than three hours, and in people who have altered lumbar lordosis, or an exaggerated curvature of the low back. The incidence of knee injuries is also a concern. An estimated 80,000 to 100,000 anterior cruciate ligament, or ACL, injuries occur annually and approximately 70 percent of these are non-contact
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dotFIT Certification
Integrated Training
1
The Scientific Rationale
Today’s Society
To understand the rationale behind integrated training, it’s imperative for the health and fitness
professional to first understand the current state of today’s society. In addition to the current obesity
epidemic, the number of older individuals is also growing rapidly. The U.S. Census Bureau reports that
the proportion of the population over 65 is projected to increase from the 12% reported in 2000 to
almost 20% by 2030. This lends to the number of individuals developing chronic diseases and
disability. In the United States, approximately 80% of all persons 65 or older have at least one chronic
health condition, and 50% have at least two. One in five adults report having doctor-diagnosed arthritis
which is a leading cause of disability in the U.S.
Meanwhile, daily activity levels continue to decline. People are less active and are no longer spending as
much of their free time engaged in physical activity. Physical education and after-school sport programs
are being cut from school budgets, further decreasing the amount of physical activity in children’s lives.
This new environment is producing more inactive and non-functional people, leading to structural
deficiencies and injury.
Evidence of Increased Injury and Musculoskeletal Pain
Research suggests that musculoskeletal pain is more common now than it was 40 years ago. This lends
support to the concept that decreased activity may lead to muscular dysfunction and, ultimately, injury.
Some of the major health topics of interest include low back pain, knee injuries, chronic diseases, such
as heart disease and diabetes, and musculoskeletal injuries.
Low back pain is one the major forms of musculoskeletal degeneration seen in the adult population,
affecting nearly 80 percent of all adults. It is common among workers in enclosed workspaces, such as
offices, as well as those who sit for periods of time greater than three hours, and in people who have
altered lumbar lordosis, or an exaggerated curvature of the low back.
The incidence of knee injuries is also a concern. An estimated 80,000 to 100,000 anterior cruciate
ligament, or ACL, injuries occur annually and approximately 70 percent of these are non-contact
dotFIT Certification
Integrated Training
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injuries. Non-contact injuries include losing your balance stepping off a curb or planting your foot to
change directions while running. Most ACL injuries occur between 15 and 25 years of age. This comes as
no surprise when considering the lack of activity and increased obesity occurring in this age group.
Another contributor to musculoskeletal injuries is poor posture, which results in increased neck, mid-
and lower back, shoulder and leg pain.
Work-related injuries are also a factor, with over 40% of reported injuries coming in the form of sprains
and strains. More than one-third of all work-related injuries involve the trunk and, of these, over 60%
involve the low back. The cost of this poor health and function? The value of lost work time due to
musculoskeletal injuries is estimated to be approximately $120 billion dollars.
So what does this all mean? Simply put, the extent to which we condition or decondition our
musculoskeletal system directly influences our risk of injury. The less conditioned we are, the higher the
risk of injury. The body is a master of adaptation. Since our daily lives include little physical activity, we
are poorly prepared to participate in recreational and leisure activities such as resistance training,
weekend sports or simply playing on the playground. For most, daily life conditions us to handle no
more than sitting still.
Traditional Training Programs
Now that we have a better understanding of today’s client, let’s take a look at how most traditional
training programs are designed and how that carries over to the needs of today’s client.
First, most traditional training programs do not emphasize movements in all three planes of motion
including the sagittal, frontal and transverse planes. Most programs include exercises that are primarily
sagittal plane dominant, or movements that are performed in a forward and backward motion.
Examples of these types of movements include rows, presses and front lunges. Rarely do you see
individuals performing exercises requiring them to move from side to side in the frontal plane or in
rotation in the transverse plane. In fact, many injuries occur while moving in the transverse plane, yet
traditional exercise programming does not challenge an individual’s ability to control themselves in this
plane. It will be important that training programs of today challenges the individuals’ ability to control
themselves in all three planes of motion.
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Integrated Training
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Second, the majority of traditional training programs do not emphasize all aspects of the muscle
contraction spectrum. Generally, the emphasis is placed on how much weight one can lift
concentrically. Rarely do you see one emphasize how slowly they can eccentrically lower the weight
back to the starting position or how well they can isometrically stabilize the load before they lift the
weight again. However, most injuries occur during the eccentric and isometric phases of movement.
Individuals are typically not trained efficiently to slow themselves down (or decelerate) nor are they
efficient in their ability the dynamically stabilize themselves. This style of training poorly equips the
exerciser to handle the dynamic requirements of an active life.
For this reason, it is important for programs of today to emphasize all three contractions of the muscle
action spectrum: the concentric contraction, or lifting the load, the eccentric contraction, or lowering
the load, and the isometric contraction to stabilize the body while performing the exercise.
Lastly, many traditional programs do not challenge individuals in proprioceptively enriched
environment. A proprioceptively enriched environment is one that challenges the internal balance and
stabilization mechanisms of the body.
Examples of this include performing a dumbbell chest press while on a stability ball or performing an
overhead press on one leg. It is important to include exercises that challenge the internal balance and
stabilization mechanisms of the body so they’ll be better prepared to control themselves and protect
against injury in unstable environments outside the gym. Doing so will also make your clients better
prepared for higher intensity exercise in the future and continuous progress towards their goals.
So with all of that said, the new mind-set in fitness should cater to creating programs that address
functional capacity, as part of a safe program designed especially for each individual. In other words,
training programs must consider each person, their environment and the tasks and activities that they
will be engaged in. This is best achieved by introducing an integrated approach to program design. It is
upon this premise that the National Academy of Sports Medicine (NASM) presents the rationale for
integrated training and the Optimum Performance Training (OPT™) model.
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Integrated Training
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Integrated Training and the OPT™ Model
Let’s first define integrated training. Integrated training is a concept that incorporates all forms of
training in an integrated fashion as part of a progressive system. These forms of training include